Platelet-Rich Plasma (PRP)

  • Platelet-rich plasma (PRP) is an autologous plasma with high concentration of platelets.
  • Human platelets are a rich source of bioactive proteins including various cytokines and growth factors, which help in hemostasis, tissue healing, and regenerative processes.
  • PRP is being used in the dermatology and cosmetology for various indication like wound healing, skin rejuvenation, and hair loss.

Definition:

  • A volume of an autologous plasma that has a platelet concentration above baseline. A normal platelet count is about 150,000-450,000 platelets per micro litre of blood. A baseline blood platelet count of 2000,000/ul can be considered average.
  • Different authors suggest different platelet concentration in PRP. Marx sates that a "working definition" of PRP is 1,000,000 platelets/ul in a 3 ml volume of plasma. On the other hand, Anitua et al mention a PRP to have platelet concentration above 3,00,000/ul. It has been suggested that PRP should achieve at least 3-5 fold increase in platelet concentration over baseline platelet count.
  • The regenerative potential of PAP depends on the numerous proteins contained within the granules of platelets that strongly influence wound healing, along with leukocytes in the PRP, and the fibrin matrix that is produced on platelet activation of the PRP.

INDICATIONS:

  • Patterned hair loss in males and females
  • Alopecia areata
  • Scarring alopecia
  • Atrophic scars
  • Facial rejuvenation
  • For faster wound healing

Who should not get PRP done?

  • Platelet dysfunction syndrome
  • Critical thrombocytopenia
  • Hemodynamic instability
  • Septicemia
  • Infection at the affected area
  • Malignancye

Instruments and Equipment:

  1. Lab centrifuge
  2. Sterile centrifuge tubes
  3. Anticoagulant ACD
  4. Scalp vein 20-G, 3,5 and 10ml luer lock syringes, needles 16-G, and 30-G needles.

PRP IN HAIR GROWTH

Mechanism of Action of PRP

The growth factors released from platelets from stem cells in the bulge area of the follicles, stimulate the development of new follicles and promote neo-vascularization.
PRP is a rich source of anagen - maintaining factors such as IGF-1, bFGF and VEGF. PRP increases the phosphorylation of extracellular signal regulated kinesis and Bcl-2 expression in dermal papilla (DP) cells and this has anti-apoptotic effect on the these cells.

Mechanism of Action of Microneeding

Microneedling with dermaroller helps stimulate hair growth in patterned hair loss. Microneedling further causes activation of stem cells in the hair bulge area during wound healing process and over-expression of the hair growth-related genes. PRP is also a source of TGF B1 that-promotes catagen, has inhibitory effect on hair growth, and promotes perifollicular fibrosis, which has been suggested as one of the pathogenic mechanisms of androgenic alopecia.

Pre procedure work-up:

  1. Investigation: photographs are taken
  2. Local anaesthesia (LA) (1% lignocaine)
  3. Microneedling of the treatment area is performed using 1.5-to 2mm needle-sized derma roller.
  4. Technique of injection of PRP into the treatment area: Inject intradermally using multiple puncture technique going deep to superficial in retrograde manner.
  5. Pour the stored PPP to cover the entire treatment area and let it dry.
  6. Procedure: Blood collection is done. Centrifugation is done. The first spin separates the blood in two layers, the upper hazy layer containing the plasma, platelets and leukocytes and lower layer containing the erythrocytes. Centrifugation of hazy aspirate leads to upper clear plasma, middle buffy coat of platelets & leukocytes and lowest containing erythrocytes.

Post procedure:

1.Antibiotic cover, avoid NSAIDS, systemic steroids and excess physical activity for 24 hours.
2.Patient can wash the scalp with povidone-iodine shampoo 6 hours after the procedure.

Schedule:

1.Every month for 3-4 months, till optimum results or improvement is seen.
2.For maintenance, injection once every 6 months up to a year.